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Fatal fulminant necrotizing pneumonia: a case report
Dante N Schiavo1, Philippe R Bauer, Vivek N Iyer
1Division of Pulmonary and Critical Care Medicine, Mayo Clinic Gonda, Building 18S, 200 First Street SW, Rochester, MN 55905, USA. schiavo.dante@mayo.edu.
Journal of Medical Case Reports
|February 7, 2014
Summary
This case report details a fatal instance of pulmonary histoplasmosis presenting as severe necrotizing pneumonia with cavitation. It highlights a rare manifestation of this fungal infection in a non-immunosuppressed individual.
Area of Science:
- Pulmonology
- Infectious Diseases
- Mycology
Background:
- Presents a rare case of fatal pulmonary histoplasmosis.
- Highlights an unusual presentation of extensive necrotizing and cavitating pneumonia.
- Emphasizes the occurrence in a patient without known immunosuppression.
Purpose of the Study:
- To report a unique case of histoplasmosis with severe lung destruction.
- To raise awareness among clinicians about atypical presentations of fungal infections.
- To underscore the importance of considering endemic mycoses in differential diagnoses.
Main Methods:
- Case report of a 45-year-old female smoker from southeastern Minnesota.
- Clinical presentation included progressive dyspnea, fatigue, and weight loss.
- Diagnostic workup involved chest computed tomography (CT) scan and bronchoalveolar lavage (BAL).
Main Results:
- CT scan revealed extensive pulmonary necrosis and bilateral cavitation.
- BAL confirmed Histoplasma capsulatum as the sole pathogen.
- The patient experienced rapid deterioration, multi-organ failure, and death despite treatment.
Conclusions:
- This case illustrates a novel and severe manifestation of histoplasmosis.
- Pulmonologists and intensivists should maintain a high index of suspicion for fungal infections.
- Atypical presentations in endemic areas warrant thorough investigation for mycotic diseases.
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